Healthcare Provider Details

I. General information

NPI: 1487714036
Provider Name (Legal Business Name): MISSI NADEAU PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48TH MDG UNIT 5115
APO AE
09461
US

IV. Provider business mailing address

2232 S MAIN ST
ANN ARBOR MI
48103-6938
US

V. Phone/Fax

Practice location:
  • Phone: 231-750-0200
  • Fax:
Mailing address:
  • Phone: 231-750-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301007867
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number6301007867
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number6301007867
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number6301007867
License Number StateMI
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301007867
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: